Maternal Obesity and the Risk of Selected Foetal Abnormalities (Neural Tube Defects and Orofacial Clefts) In Malaysia: A Retrospective Observational Study

Objective: To evaluate the association between maternal obesity and the risk of selected foetal abnormalities (neural tube defects and orofacial clefts) in Malaysia. Materials and Methods: We conducted a single-centre retrospective observational study on all women who delivered at Hospital Sultanah Aminah Johor Bahru, Malaysia from 1st January 2017 to 31st December 2018. The presence of neural tube defects (NTD) and orofacial clefts (OC) were identified from medical records, including all live births, stillbirths and terminations of pregnancy. All deliveries during the study period were reviewed to collect data on maternal weight, height and demographics. We performed multiple logistic regression to estimate factors contributing to selected anomalies. Results: A total of 28,228 pregnancies were included. There were 57 NTD-affected pregnancies and 34 OCaffected pregnancies identified during the two-year study period. There was no statistically significant association found between maternal obesity and the occurrence of NTDs or OCs. Pre-gestational diabetes had a significant association with NTD-affected pregnancies (aOR 3.454, 95% CI [1.017, 11.725], p=0.091). The highest incidence rate of NTDs was among Malaysian Indians (2.540 per 1,000 deliveries). Malaysian Chinese and Malaysians of other ethnicities were found to have a significantly higher risk of having OC-affected pregnancies with aOR of 2.371 (95% CI [1.035-5.428], p=0.024) and 4.910 (95% CI [1.454-16.579], p=0.024) respectively. Conclusion: Our study showed no significant association between maternal obesity and selected foetal abnormalities (NTD and OC), and that pre-gestational diabetes is a significant risk factor for NTD in Malaysia.